=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922993500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOWDIE FAMILY CARE CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2025
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 OGLETHORPE AVE STE 3500
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30606-2191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-410-2684
-----------------------------------------------------
Fax | 706-413-1746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 OGLETHORPE AVE STE 3500
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30606-2191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-410-2684
-----------------------------------------------------
Fax | 706-413-1746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STALINA GOWDIE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 706-410-2684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------